Ultrasonographic mound height as predictor of vesicoureteral reflux resolution after endoscopic treatment in children

Zambaiti, Elisa; Pensabene, Marco; Montano, Valentina; Casuccio, Alessandra; Sergio, Maria; Cimador, Marcello

doi:10.1016/j.jpedsurg.2016.01.021

Cited by 14 publications

(13 citation statements)

References 11 publications

(14 reference statements)

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“…Reported predictors for success include a volcano-like mound appearance [16], mound height (as assessed by ultrasound) [17] and injection volume [18]. Moreover VUR grade [19] and timing of VUR are suspected predictors [20].…”

Section: Discussionmentioning

confidence: 99%

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Maruyama¹,

Mizuno²,

Nishio³

et al. 2021

Preprint

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Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in adult patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer /hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range: 15 to 61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in adult patients with dilated ureteral orifice.

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Section: Discussionmentioning

confidence: 99%

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Maruyama¹,

Mizuno²,

Nishio³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Reported predictors for success include a volcano-like mound appearance [ 17 ], mound height (as assessed by ultrasound) [ 18 ] and injection volume [ 19 ]. Moreover, VUR grade [ 20 ] and timing of VUR are suspected predictors [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

et al. 2021

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Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15–61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13–63) months long. Although, 3 patients were experienced f-UTI 1–2 times, repeated VCUG showed no VUR recurrence. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.

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“…Zambaiti et al reported that PUM height was predictive of radiologic success with a sensitivity and specificity of 100% and 66%, respectively, using a height cut off of 9.8 mm. 27 Park et al graded the PUM (1-3) and found more pronounced and protruding PUMs to be more predictive of radiologic success. 28 More recently, the use of an intraoperative US-assisted approach for endoscopic VUR correction was investigated.…”

Section: Discussionmentioning

confidence: 99%

Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux

Wang

Abdelhalim

Walia

et al. 2018

CUAJ

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Introduction: Variability in the success rates for the endoscopic correction of vesicoureteral reflux (VUR) has prompted a debate regarding the use of routine postoperative voiding cystourethrogram (VCUG). This study examines the predictive performance of intraoperative mound morphology (IMM) and the presence of a postoperative ultrasound mound (PUM) on radiologic success, as well as investigates the role of using these two predictive factors as a composite tool to predict VUR resolution after endoscopic treatment. Methods: This retrospective study included children with primary VUR who underwent endoscopic correction with a double hydrodistension-implantation technique (HIT) and dextranomer/ hyaluronic acid copolymer. IMM was assessed intraoperatively. The presence of a PUM and VUR resolution were assessed by postoperative ultrasound (US) and VCUG, respectively. Radiologic success was defined as VUR resolution. Results: A total of 70 children (97 ureters) were included in the study. The overall radiologic success rate was 83.5%. There was no statistically significant association between radiologic success and IMM (85.2% with excellent and 87.5% with “other” morphology; p=0.81). The sensitivity and specificity of PUM for radiologic success in this study was 98% and 71%, respectively, while the sensitivity and specificity of the combined prediction model were 81.9% and 85.7%, respectively. Conclusions: We objectively demonstrated that IMM was a poor predictor of radiologic success and should be used with caution. In addition, the performance of a combined prediction model was inferior to the presence of a PUM alone. As such, selective use of postoperative VCUG may be guided solely by the presence of a PUM.

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Ultrasonographic mound height as predictor of vesicoureteral reflux resolution after endoscopic treatment in children

Cited by 14 publications

References 11 publications

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux

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